Racial differences in the use of specific infertility services among service users.

Existing literature surrounding infertility and infertility services has focused on White women; however, little attention has been given to how these services are used by Black women. This dissertation examines the effects of race, exclusively among Black and White infertility service using women, on the use of specific infertility services. It further considers how age, income, insurance status, educational attainment, state of residence, and partner status impact these rates. This secondary analysis of data from the National Survey of Family Growth examined the relationship between race and services usage, defined as seeking infertility services advice, infertility testing, artificial insemination(AI), in vitro fertilization (IVF), gamete intrafallopian transfer (GIFT), zygote intrafallopian transfer (ZIFT), ovulation drugs, or endometriosis, fibroid or tubal surgeries or treatments. By applying multivariate logistic regression techniques to data from a nationally representative sample, this study explored how race, along with the other covariates, influenced the use of specific services, whether the gap in the use of these services by race was increasing between 1995 and 2002, and how state of residence influenced infertility services usage rates among Black and White women. Results indicate that Black women use specific infertility services at the same rates in 2002 as they did seven years earlier and for White women the rates are increasing. Therefore the gap is widening between Black and White women. Nearly all women in the survey sample have taken advantage of less invasive infertility services, however, a higher percentage of Black service using women have utilized more invasive services than White service using women. State of residence is important in determining the rates of use of infertility advice and AI/IVF/GIFT/ZIFT. Specifically, for women living in states with mandated health insurance coverage of infertility services, White women have significantly higher rates of services treatment than Blacks. It is imperative to increase access to infertility services by implementing additional state mandates of insurance coverage as well as through enhancing access within governmental insurance programs due to significantly increased rates of AI/IVF/GIFT/ZIFT usage among women living in states mandating insurance coverage. Further investigations should focus on Black women specifically, and the reasons for their use or nonuse, of infertility services.PhDHealth and Environmental SciencesObstetricsPublic healthUniversity of Michigan, Horace H. Rackham School of Graduate Studieshttp://deepblue.lib.umich.edu/bitstream/2027.42/126449/2/3253297.pd